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Comparing treatment delays and pathways to early intervention services for psychosis in urban settings in India and Canada

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Abstract

Introduction

Although extensively studied in high-income countries (HICs) and less so in low- and middle-income countries (LMICs), pathways to care and treatment delays in early psychosis have not been compared across contexts. We compared pathways to early intervention for psychosis in an HIC (Montreal, Canada) and an LMIC (Chennai, India). We hypothesised that the duration of untreated psychosis (DUP) would be longer in Chennai.

Methods

The number of contacts preceding early intervention, referral sources, first contacts, and DUP and its referral and help-seeking components of first-episode psychosis patients at both sites were similarly measured and compared using chi-square analyses and t tests/one-way ANOVAs.

Results

Overall and help-seeking DUPs of Chennai (N = 168) and Montreal (N = 165) participants were not significantly different. However, Chennai patients had shorter referral DUPs [mean = 12.0 ± 34.1 weeks vs. Montreal mean = 13.2 ± 28.7 weeks; t(302.57) = 4.40; p < 0.001] as the early intervention service was the first contact for 44% of them (vs. 5% in Montreal). Faith healers comprised 25% of first contacts in Chennai. Those seeing faith healers had significantly shorter help-seeking but longer referral DUPs. As predicted, most (93%) Montreal referrals came from medical sources. Those seeing psychologists/counsellors/social workers as their first contact had longer DUPs.

Conclusion

Differences in cultural views about mental illnesses and organizational structures shape pathways to care and their associations with treatment delays across contexts. Both formal and informal sources need to be targeted to reduce delays. Early intervention services being the first portal where help is sought can reduce DUP especially if accessed early on in the illness course.

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Data availability

Data are not available as consenting participants did not agree to their data being shared widely. Nonetheless, please contact the corresponding author for any data requests.

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Acknowledgements

We thank the PEPP and SCARF teams, patients, and families; and Dr. Howard C. Margolese for facilitating data collection at the PEPP-MUHC program. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: this research was funded by an R-01 grant (no. 5R01MH093303-05) and an associated supplemental grant (no. R01MH093303-04) from NIH. S.N.I. has received a grant and salary award from the Canadian Institutes of Health Research and a salary award from the Fonds de recherche du Québec–Santé. A.M was funded by Canada Excellence Research Chairs, Government of Canada. K.M received a doctoral award from Fonds de recherche du Québec Santé. G.M received doctoral funding from NIHR Research, U.K and TATA Trusts, India. The funding source had no role in study design, data collection and analysis, writing of the report, and in the decision to submit the report for publication.

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Author notes

  1. Kathleen MacDonald and Greeshma Mohan contributed equally as first authors.

  2. Ashok Malla and Srividya N. Iyer contributed equally as senior authors.

Authors and Affiliations

  1. Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Wilson Pavilion, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada

    Kathleen MacDonald, Nicole Pawliuk, Ridha Joober, Ashok Malla & Srividya N. Iyer

  2. Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada

    Kathleen MacDonald, Ridha Joober, Ashok Malla & Srividya N. Iyer

  3. Schizophrenia Research Foundation (SCARF), R-7A North Main Road, Anna Nagar West Extension, Chennai, Tamil Nadu, 600 101, India

    Greeshma Mohan, Ramachandran Padmavati & Thara Rangaswamy

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  1. Kathleen MacDonald
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Contributions

Study design and protocol: SNI, AM, RT, RP, RJ; implementation and data acquisition: SNI, GM, AM, RP, RJ; data analysis: KM, NP; statistical input and interpretation: SNI, NP, KM, AM, RJ, RT, RP; first draft of the manuscript: KM, GM,SNI; all authors contributed to several drafts and have approved the final manuscript.

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Correspondence to Srividya N. Iyer.

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MacDonald, K., Mohan, G., Pawliuk, N. et al. Comparing treatment delays and pathways to early intervention services for psychosis in urban settings in India and Canada. Soc Psychiatry Psychiatr Epidemiol 58, 547–558 (2023). https://doi.org/10.1007/s00127-022-02414-8

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